Women's Health Newsletters 11/17/02- 1/26/02
- November 17, 2002
- December 1, 2002
- December 15, 2002
- December 29, 2002
- January 12, 2003
- January 26, 2003
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****** Woman's Health Newsletter ******* November 17, 2002 ~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~ Biweekly from BackupMD on the Net ~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~ 1. Mild endometriosis and chances to conceive 2. Stress fractures 3. Reader submitted Q&A-Repeat miscarriage 4. Women and men "feel" strokes differently 5. Health tip to share - Effexor XR(R) continued 6. Humor is healthy ~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~ 1. Mild endometriosis and chances to conceive ~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~ The optimal treatment for women with minimal and mild endometriosis (stages 1 and 2) in order to improve their chances of conception, is not totally clear. Many studies have suggested that neither surgery nor medical treatment really improves the chances of getting pregnant for early stage endometriosis. Stage 1 and 2 endometriosis involves small spots of powder burn-like lesions (tissue from the uterine lining) located in the abdominal cavity. These lesions are usually behind the uterus but do not involve adhesions (scar tissue) or the ovaries or bowel. Stage 1 has only a few lesions (typically less than 10) that are not very deep while stage 2 has more and deeper lesions but again not involving the ovaries or bowel or adhesions. Although the criteria surgeons use are somewhat subjective, it has served as a useful classification to distinguish different degrees of endometriosis spread. The following study from Greece looked at 151 women who were diagnosed with stages 1 and 2 endometriosis and who wanted to become pregnant. A third were treated with laparoscopic excision and cautery of the endometriosis, a third were given medical therapy and a third were given no treatment at all. The women were then followed for two years. Pregnancies occurred in 36.7%, 30.5% and 20.9% respectively. Not all pregnancies resulted in live births but 30.6%, 25.4% and 16.2% respectively continued beyond the first trimester when most miscarriages occur. Keep in mind that over two years, about 60-80% of normally fertile women will become pregnant. This study points out the reduced pregnancy rate with endometriosis. It also points out that it is possible to become pregnant even without any treatment but at a low rate (16%). Endometriosis is still an enigmatic disease that needs further research. Endometriosis stage and ability to conceive ~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~ 2. Stress fractures ~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~ Too much exercise too soon. That's the cause of tiny stress fractures of the bone. Women are more prone to them than men, presumably because of less muscle mass to protect bones from high impact exercises. Stress fractures occur when the muscles become tired and the bones of the feet and legs have to absorb the impact of running or jumping. Joggers, basketball players, tennis players, gymnasts and volleyball players are very susceptible to stress fractures but the most frequent injuries occur to casual exercisers who try too much too soon. After the winter season when individuals decide to rid themselves of winter fat, physicians start to see foot and leg pain that ends up being diagnosed as stress fractures. Even prolonged walking and hiking as exercise can lead to stress fractures. MRI may be used to diagnose stress fractures since they may not always show up on conventional x- rays. Even if you develop a "plantar fasciitis" from walking, you may want to have an MRI to make sure the persistent pain is not from a stress fracture. Treatment of a stress fracture is merely to avoid the activity that caused the fracture. The bone does not need to be splinted or cast. It just needs to avoid any repetitive trauma. Stress fractures can heal on their own if given time. Additional treatment includes: Ice the area to reduce swelling and pain. Elevate the area to relieve symptoms. Control pain with acetaminophen (Tylenol(R), others) or ibuprofen (Advil(R), Motrin(R)). See your doctor if pain lasts longer than 2-3 days ~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~ 3. Reader submitted Q&A - Repeated miscarriage ~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~ "What sorts of things can cause a woman to spontaneously miscarry a fetus only a few weeks after conception?" "I'm 38 and the few times in my life I have managed to conceive, I lose the fetus right away, with 2 weeks of the positive home pregnancy test (or within 3-4 weeks after conception)- too fast for me to even get into to see a doctor. I and my partner (of three years) were treated for a mycoplasma infection found 2 years ago, but my doc could not find anything else wrong. Hormone test: progesterone & testosterone levels are higher than average but still barely within normal limits. Estrogen was within normal limits but the ratio of estrogen to the other hormones was low. (I've been experiencing perimenopausal symptoms for 2 years). This miscarriage problem dates back to when I was only 16 and has occurred at least three or four times over the last 22 years; I've never been able to carry longer than those few weeks. I'm still childless and running out of time." - LSB Miscarriages are more common than most people think. It is estimated that 1 million of the 6 million pregnancies each year in the U.S. end up as a miscarriage. For any one pregnancy, a woman has about a 1 in 7 chance of miscarrying. As many as 5% of couples have 2 miscarriages in a row and about 1% of couples have 3 miscarriages in a row. This situation is often labeled as habitual abortion although a better term is recurrent pregnancy loss (RPL). Frequent miscarriages are of great concern to many women even though statistically a woman who has 3 miscarriages in a row still has a 50-70% chance of conceiving and carrying a normal pregnancy the next time she becomes pregnant. I find that the biggest problem is the discouragement that women have. Often they are unwilling to try again faced with the prospect that there can be up to a 50% chance they would miscarry. When this problem occurs, couples are very susceptible to any diagnosis and treatment suggestions that doctors offer - perhaps sometimes too much so. There are some conditions that seem to predispose to recurrent loss. After 3 miscarriages, the typical diagnostic studies and procedures that are recommended are: Laboratory Tests thyroid stimulating hormone (TSH)- to detect hyper or hypothyroidism serum progesterone (day 21-22 of cycle) - to detect adequate corpus luteum function parental (both) blood chromosome analysis - to determine if there might be a hereditary genetic cause lupus anticoagulant - to detect antiphospholipid syndrome anticardiolipin antibodies - to detect antiphospholipid syndrome Procedures hysterosalpingogram or hysteroscopy - to detect anomalous shapes of the uterus pelvic ultrasound - to detect fibroids of the uterus It sounds as if your doctor has concentrated on possible hormone abnormalities although those have not really been shown to be a cause of recurrent pregnancy loss. You might try a second opinion from another gynecologist or a reproductive endocrinologist and discuss if you need some of the above studies. You are now old enough that age plays a role that it may not have when you were younger. ~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~ 4. Women and men "feel" strokes differently ~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~ Common symptoms of a stroke include difficulty speaking, facial muscle paralysis or weakness, dizziness and areas of numbness over the arms, legs or body. Many women, however, do not always present with these classic symptoms but rather they describe atypical stroke symptoms such as pain in the arms and legs, disorientation and changes in consciousness. Almost 30% of the time women have stroke symptoms not usually described as typical signs. Part of the difference may be that women experience more bleeding (hemorrhagic) strokes while men experience more occlusion of the blood vessels (thrombotic strokes) in the brain. This difference, however, does not totally explain why many women have different stroke symptoms than men. Some investigators think that the symptoms are the same but women just describe them differently than men. (That may be true but my wife believes it is because women use both sides of their brain to think and describe while men mostly use only one side! From my point of thinking, she may be half right.) Women also suffer more strokes than men (62% of stroke deaths) but investigators point out most of the difference is due to living longer than men, since strokes increase in frequency with age. Non neurological signs also described more often by women having strokes, are chest pain and shortness of breath. The bottom line is that women should be aware of this variation in symptoms and seek out diagnosis if there are acute episodes of arm or leg pain, disorientation, loss of consciousness (fainting) or chest pain and shortness of breath. Women and men feel strokes differently ~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~ 5. Health tip to share - EffexorXR (R) continued ~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~ "Just wanted to tell the lady who is on Effexor XR for night sweats that I had to stop taking it (at the same dose, 75 mg, which she stated is a small dose and it is actually a very common dose) because it increased my appetite greatly and I gained 12 pounds in 2 1/2 months. It also made me lethargic. Be careful driving on it!" - Suzy [editor note - This just reminds us that health tips or any suggested medical therapies do not always work the same for everyone. Be cautious with medications but at the same time don't reject a recommended alternative treatment just because it did not work out for someone you know.] If you have discovered ways of coping with a disease or condition and it works for you, please share it with us: Health tip suggestion form ~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~ 6. Humor is healthy ~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~ "Games For When We Are Older..... " Remember the games you used to play at birthday parties when you were young? Capture your youth again at your next birthday with these matured- with-age games: 1. Sag, You're it. 2. Pin the toupee on the bald guy. 3. 20 questions shouted into your good ear. 4. Kick the bucket. 5. Red Rover, Red Rover, the nurse says Bend Over. 6. Doc Goose. 7. Simon says something incoherent. 8. Hide and go pee. 9. Spin the bottle of Mylanta. 10. Musical recliners. ~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~ That's it for this time. Your BACKUPMD on the Net. Rick Frederick R. Jelovsek MD ~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~
****** Woman's Health Newsletter ******* December 1, 2002 ~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~ Biweekly from BackupMD on the Net ~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~ 1. Alternative arthritis treatments 2. Growth hormone for older women 3. Reader submitted Q&A - Aortic aneurysm 4. Beta blocker meds help the heart 5. Health tip to share - Cranberry juice for odor 6. Humor is healthy ~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~ 1. Alternative arthritis treatments ~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~ Arthritis sufferers are well known to be willing to try almost any alternative medical treatment in order to obtain relief from the almost constant joint pain. Many alternative treatments are advertised as "natural". You must remember, however, that natural does not always equate to "safe". Some treatments may have scientific evidence suggesting they may help while most are unproven and some are even dangerous because of side effects or impurities in manufacturing. Herbal treatments such as evening primrose oil and capsicum for rheumatoid arthritis and ginger as a treatment for osteoarthritis may have some benefits. Most other herbs have not been shown to be beneficial. One example is a Chinese medicine, Tripterygium wilfordii Hook F (TwHF) to treat inflammation and musculoskeletal injuries but it it becomes toxic at high doses. Certain nutritional supplements have received attention and may be beneficial for arthritis. The best data exists for glucosamine use with osteoarthritis. Chondroitin sulfate may have similar benefits also although the data is not as clear. Vitamins C, D and E have shown some promise in osteoarthritis although too much vitamin A may worsen it. S-adenosyl-methionine (SAM-e) is another supplement that has been used and it may help with the pain of arthritis. More trials need to be conducted but there is promise for SAM-e. Metals have also been used. Copper bracelets are ineffective but harmless whereas gold injections may have a positive benefit but side effects can be significant. Magnets have also been used but there is little good data to support their use. Many other modalities have been used to combat the pain and inflammation of arthritis such as relaxation techniques, acupuncture, aroma therapy and others. All have had mixed results. Sometimes food allergies may be linked with arthritis but dietary changes should only be based on food allergy testing otherwise it is almost impossible to tell what foods to eliminate. The urge to try additional treatments for arthritis is real, but try to use some judgment before investing heavily in time and money to self test these alternative treatments. ~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~ 2. Growth hormone for older women ~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~ Some think growth hormone is the fountain of youth. There is evidence that it increases muscle mass in older adults just like your body did when you were a teenager. Growth hormone has to be given by injection and it is terribly expensive so it is not likely to be used on a large scale basis at the current time. Unscrupulous entrepreneurs have taken advantage of the theoretical benefits of growth hormone by offering derivatives, chemical precursors and even animal growth hormone sources to entice money from those who want to stay young forever. These products do not work! As investigators have begun to study the potential of growth hormone, one of the questions that needs to be answered is what are the interactive effects of growth hormone (GH) and sex steroids such as estrogen in women or testosterone in men. We need to know if the sex steroids have any influence on muscle strength and endurance. The following U.S. study of community dwelling men and women lasted 26 weeks. They gave growth hormone and placebo as well as sex hormones and placebo to 57 women and 74 men testing all combinations. Women increased their lean body mass by about: 0.8 lb on placebo 2.5 lbs with hormone replacement therapy (HRT) alone 2.2 lbs with growth hormone alone 4.6 lbs with growth hormone plus HRT Men had similar changes. All of this weight was muscle mass and not fat. There were some side effects. Women had no significant change in their strength or cardiovascular endurance. They also had a problem with edema when taking growth hormone alone or growth hormone plus HRT. Men had problems with diabetes and glucose intolerance as well as joint pains. While there may be some medical benefits from growth hormone, it does not appear to be a fountain of youth and there are side effects from the treatment. Hopefully further studies will clarify when it should be used (eg. muscle wasting in the elderly). Growth hormone for older women ~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~ 3. Reader submitted Q&A - Aortic aneurysm ~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~ "A year ago, I had a lower abdominal scan due to a mass in my left side. This turned out to be an ovarian cyst. However, I saw the report, and it indicated evidence of an aortal aneurysm and a spot on my liver. I have a history of melanoma. There has been no mention of the aneurysm or liver abnormality by either my family doctor or surgeon. Is this something that should be checked further? Should my doctor have told me of this?" - J.H. I think your doctor should have mentioned these findings to you and made a plan for continued evaluation. I'll bet it either was an oversight or the aneurysm was very small and the doctor did not want to "worry" you about it because most aneurysms do not get large and rupture. However there is a trend now to do screening ultrasounds and if the aneurysm gets bigger, then surgery is recommended. Such surgery is very major so it should not be undertaken lightly. In one screening study, aneurysm was defined as a maximum aortic diameter of 3 cm or more. Annual re-scanning took place if the diameter was 3 - 4.4 cm, and at three-monthly intervals if it was 4.5 - 5.9 cm. This protocol was continued until patients either died or underwent surgery or declined further follow-up. Aortic diameters of 6 cm or more, and an increase of diameter of 1 cm or more in a year, or developments of symptoms attributable to the aneurysm all constituted criteria for considering surgery. The main symptom from an abdominal aortic aneurysm is back pain. It is not worsened by movement but is present most of the time. It is a mid back pain rather than the common low back pain with movement that many people have. A pulsating feeling in the abdomen and abdominal pain are other symptoms that people have. Because aneurysms are often caused by atherosclerosis, there is a higher frequency in men than women but women get them too. Until the recent improvement in imaging technology, most aneurysms were only discovered on plain x-rays if they were very big and calcified. Now, imaging technology has improved and we are realizing that aneurysms are more common. I think that you should be followed for this and I would suggest asking your doctor to be referred to a vascular surgeon for an opinion as to whether anything should be done right now. It is hard to tell from what you describe whether this is an incidental finding or something that is potentially serious but I would consider it serious until a vascular surgeon evaluates you and the ultrasound findings. The liver abnormality is probably not related to the aneurysm but with a history of melanoma, that also should be evaluated by your oncologist just to make sure. Now that you have seen the report ask the doctor about it. I'm sure that since a year has passed they will want another scan to see if either finding has changed in size. ~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~ 4. Beta blocker meds help the heart ~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~ After a heart attack, arrhythmia, abnormal heart rate rhythms may develop along with weakness of the heart muscle. One medicine commonly used after heart attacks is called a "beta blocker". Inderal (propanolol) is the most common but others like Atenolol, Labetolol and Toprol XL are frequently used. These meds block the stimulating effect of epinephrine on the heart. A recent study shows that patients who were continued on the beta-blockers even long after their heart attack occurred still have a lower death rate. It was 16 % lower after two years and 34% lower after 5 years compared to people who did not get continued on them. If you or a relative have had a history of a heart attack or major heart arrhythmia, be sure to discuss with the doctor about continuing to take a beta blocker. Patients who have high blood pressure are often continued on beta blockers but if there is no hypertension, sometimes the medication is just forgotten. Beta blocker meds help the heart ~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~ 5. Health tip to share - Cranberry juice for vaginal odor ~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~ "Cranberry juice, everyday, helps with my vaginal odor. I am diabetic and suffer from vaginal odor, even if I am not experiencing a yeast infection. I understand that vaginal odor can also be caused by liver and kidney function, so the cranberry juice makes sense. I have also heard that some herbal remedies intended for liver and kidney function improve vaginal odor." - I.N, If you have discovered ways of coping with a disease or condition and it works for you, please share it with us: Health tip suggestion form ~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~ 6. Humor is healthy ~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~ "Shingles" A man walked into a doctor's office and the receptionist asked him what he had. He replied, "I got shingles." She said, "Fill out this form and supply your name, address, medical insurance number. When you're done, please take a seat." Fifteen minutes later a nurse's aide came out and asked him what he had. He said, "I got shingles." So she took down his height, weight, and blood pressure, then said, "Change into this gown and wait in the examining room." A half hour later the doctor came in and asked him what he had. He said, "Shingles." The doctor gave him a full examination, and then said, "Well, I just checked you out thoroughly, and I can't find shingles anywhere." The man replied, "That's because they're outside in the truck. Where do you want them?" ~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~ That's it for this time. Your BACKUPMD on the Net. Rick Frederick R. Jelovsek MD ~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~
****** Woman's Health Newsletter ******* December 15, 2002 ~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~ Biweekly from BackupMD on the Net ~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~ 1. Diagnosing Alzheimer's disease 2. Nut and peanut butter consumption and diabetes 3. Reader submitted Q&A - SSRI side effects 4. Chronic pelvic pain from a bladder source 5. Health tip to share - Ear pain after flying 6. Humor is healthy ~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~ 1. Diagnosing Alzheimer's disease ~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~ There is no easy way to diagnose Alzheimer's disease short of performing a brain biopsy and looking at nerve tissue under the microscope. So if you suspect one of your loved ones may be developing Alzheimer's disease (AD), what do you do? Doctors basically use three different modalities to make the diagnosis: interview of the patient and family to learn how any symptoms have developed over time physical exam and laboratory testing to rule out other causes of forgetfulness or dementia such as drugs, heart failure, diabetes, stroke, brain tumor, anemia, thyroid disease, Parkinson's disease testing with mental awareness tests and imaging studies such as MRI or PET scans to add weight to the diagnosis of AD There is no one test that can say whether AD is present. Also it is difficult by any means to diagnose early disease at a time when there is only mild cognitive impairment. This mild cognitive impairment is a condition in which a person still has good judgment and decision making skills but has more recent memory loss than would be normal for one's age. It is a stage of "sharp mind but shaky memory". A person would have the most trouble remembering recent conversations and appointments, while recall of long ago events remains intact. Mild cognitive impairment does not always progress to Alzheimer's, but 50% of the time it does. Early symptoms can include loss of smell particularly with the lack of awareness of this smell deficit, loss of emotional reaction to forgetfulness (most people feel bad about forgetting appointments or recent information given to them), and inability to carry on a thought-provoking conversation. You can only use these as clues; mental assessment tests administered by psychiatrists, psychologists or geriatric specialists are much more diagnostic. If you suspect a loved one may have some impairment, seek a physician's help. Diagnosing Alzheimer’s disease ~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~ 2. Nut and peanut butter consumption and diabetes ~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~ Nutritional studies that are based on dietary histories taken from men and women always engender some suspicion when investigators announce that a certain food may be associated with a higher or lower incidence of a given disease. The problem is that people make many different choices in their lives that may influence a given disease just as they make food choices. In spite of the bias inherent in dietary studies, they often are the best measure to indicate possible new food/disease relationships that we have not been aware of before. Unsaturated fat (polyunsaturated and mono unsaturated) are thought to improve glucose and insulin balance in the body. thus they may have a role in preventing diabetes. Nuts are high in unsaturated fats and other nutrients that affect sugar metabolism. A recent study in the Journal of the American Medical Association looked at whether increased nut and peanut butter consumption played any role in the future development of adult onset of diabetes. The study referenced below analyzed data from the large Nurses Health Study and looked at over 83,000 women aged 34 to 59 years who had no history of diabetes, cardiovascular disease, or cancer prior to entry into the study in 1980. They were followed on the average of 16 years and completed dietary history questionnaires at the start of the study. They corrected the data for patient weight (BMI), physical activity and alcohol and tobacco use. The authors found that women who indicated that they ate nuts 5 or more times a week had a 23% lower incidence of developing diabetes. Women who ate peanut butter 5 or more times a week had a 21% lower incidence of diabetes. Both of these were compared to women who almost never ate nuts or peanut butter. The authors did further adjustment for intakes of dietary fats and cereal fiber but it did not appreciably change the results. If you just add nuts to your diet without decreasing other calories, that would likely cause diabetes. Therefore the authors caution To avoid increasing caloric intake but "regular nut consumption can be recommended as a replacement for consumption of refined grain products or red or processed meats." Nut and peanut butter consumption and diabetes ~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~ 3. Reader submitted Q&A - SSRI side effects ~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~ "I read with interest the recent health tip related to Effexor(R). I would be interested in comments on side effects of SSRIs. I had very bad reactions to both Paxil(R) and Zoloft(R) and I've done fine on Effexor(R). In fact, it works as an appetite suppressant, the opposite of what a reader said in a recent newsletter." "My question is: What do we know about side effects and these drugs? Why do you find side effects listed as "lethargy or insomnia", "weight gain or loss"? Do we know what's going on?" - Judy Great question. I'm not sure I can adequately answer it but let me give it a try. The selective serotonin reuptake inhibitors (SSRIs) include Paxil(R), Zoloft(R), Prozac(R), Celexa(R) and a few others. Effexor(R) has a mixed mechanism of action, so is not officially an SSRI but it is used for similar indications. The SSRIs as a class of drugs were thought to have minimal side effects compared to other prescription medications used for depression and disorders such as panic attacks, generalized anxiety and phobias. They have been used over the past decade and the side effect profile is still favorable but some people have reactions nonetheless. The commonly described side effects are nausea, diarrhea, headache, agitation and insomnia. Loss of sexual desire and sexual dysfunction are also frequently cited. I think you can see how insomnia can lead to fatigue and lethargy. If loss of sexual desire is part of depressive symptoms, you can also imagine that if the depression is made better, a person might claim improvement in sexual desire while another person who did not have loss of libido might develop that as a side effect from the SSRI. Weight loss and weight gain might be considered opposite side effects and you would wonder how one drug could produce these opposite effects. To answer that you would have to answer the question why some people with excessive nervousness eat and gain weight while others lose weight due to that same degree of anxiety. Many drugs can cause both diarrhea and constipation and we don't really know why. The truth is that we know very little about how side effects are produced by these medicines. Sometimes a side effect is just a coincidental change in symptoms or the result of some other medication or environmental cause and it is misinterpreted as being due to the primary medicine. We know from studies of active drug versus placebo that there still can be a high incidence of nausea, headache, fatigue etc. in the placebo group. This must mean these are just coincidental symptoms but since they happen also in the active drug group, they become listed as side effects. When any one person says that they developed symptom "X" from taking a new medicine, they can be right or wrong about the medicine as the cause. Thus with new medicines, doctors do not know what are the common side effects until they have had many patients on that drug and enough return visits to be able to gauge what the most common adverse reactions are. ~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~ 4. Chronic pelvic pain from a bladder source ~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~ Chronic pelvic pain is very often attributed to conditions of the pelvic reproductive organs such as the uterus, tubes or ovaries. Sometimes, however, the pain may be arising from the bladder which is also located in the pelvis. Bladder infections usually produce urinary frequency along with painful voiding. However, urinary tract infections are episodic; they do not tend to produce a constant, chronic pain. The main bladder condition that causes a chronic pain is one called interstitial cystitis. Interstitial cystitis is characterized by an inflammatory response in the bladder wall but bacterial cultures are negative. Antibiotics do not help the pain and urinary frequency. End stage interstitial cystitis (IC) often results in ulcers in the bladder wall that can be seen when a scope (cystoscopy) is used to view the inside of the bladder. The skin lining the bladder wall is usually waterproof. In other words the waste products and salts in urine never touch the nerve endings and blood vessels in the layer under the bladder skin (epithelium). Ulcers allow direct contact to this layer and produce pain and often urinary frequency. Concepts about IC are changing, however. It used to be thought you did not get bladder pain until there was an ulcer present. Now it is felt that in early disease there may be small holes, leaking in the bladder skin, that allow urine salts to get to the nerve endings and cause pain for years before there are actual ulcers. A test has been developed to see if this leaky epithelium is present. It is called a potassium sensitivity test. In this test, a mild potassium salt solution is instilled into the bladder by a catheter. If it produces a severe pain compared to instilling just sterile water, then the test is considered positive. Patients who have a positive test often respond (about 60% of the time) to a medicine used to treat interstitial cystitis called pentosan polysulfate (Elmiron(R)). This is significant because up until now, we have not had any good medicines that permanently treat pelvic pain. With this concept in mind, i.e., that maybe many instances of chronic pelvic pain really represent an early bladder skin dysfunction (IC), investigators set out to test if women with chronic pelvic pain who were not diagnosed as having chronic bladder problems, might have positive potassium (K+Cl) sensitivity tests. They found that in 244 women with pelvic pain, 81% had a positive potassium sensitivity test. None of the 47 control patients had a positive test. This would indicate that possibly these women may have an early interstitial cystitis and may benefit from therapy for it. Chronic pelvic pain from a bladder source ~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~ 5. Health tip to share - Ear pain after flying ~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~ Individuals who fly when they have a cold or sinus congestion risk blockage of the Eustachian tube that can result in ear pain, infection, hearing loss, ear ringing and dizziness. To help prevent this, use a decongestant nasal spray such as oxymetazoline (Afrin(R), Dristan(R)) or medications containing pseudoephedrine (Actifed(R), Sudafed(R)) an hour before takeoff and an hour before landing. This can help prevent blockage that leads to ear pain or damage. - FRJ If you have discovered ways of coping with a disease or condition and it works for you, please share it with us: Health tip suggestion form ~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~ 6. Humor is healthy ~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~ "Painful Side" At Sunday School they were teaching how G~d created everything, including human beings. Little Johnny, a child in the Kindergarten class, seemed especially interested when they told him how Eve was created out of one of Adam's ribs. Later in the week his mother noticed him lying down as though he were ill, and asked, "Johnny what is the matter?" Little Johnny responded, "I have a pain in my side. I think I'm going to have a wife." ~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~ That's it for this time. Your BACKUPMD on the Net. Rick Frederick R. Jelovsek MD ~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~
****** Woman's Health Newsletter ******* December 29, 2002 ~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~ Biweekly from BackupMD on the Net ~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~ 1. Antidepressant use and pregnancy 2. Alzheimer's disease and vitamin B3 - niacin 3. Reader submitted Q&A - Serzone(R) warning 4. Gingivitis 5. Health tip to share 6. Humor is healthy ~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~ 1. Antidepressant use and pregnancy ~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~ The newest class of antidepressant drugs called selective serotonin reuptake inhibitors (SSRIs- Paxil(R), Prozac(R), Zoloft(R)) are so widely used now for treating depression and other anxiety- related disorders that concern has been raised about their possible effects in pregnancy. It used to be that pregnant mothers were advised to stop almost all medications during pregnancy but as information evolves that certain drugs seem to be safe, it becomes common to see mothers on more and more prescription medicines while they are pregnant. SSRIs have been shown in other studies not to produce birth defects or developmental abnormalities and not to produce behavioral changes in newborns. Therefore doctors have allowed women to stay on these medicines when they become pregnant. The study below in the American Journal of Psychiatry looked at a group of women using SSRIs who became pregnant and found that although there was no increase in birth defects, the babies were born about a week earlier (prematurely) than were babies whose mothers did not take SSRIs. A week premature (on the average) does not seem like much of a difference but it can sometimes be a key difference in survival. This is the first report that I know of that implies there may be an adverse effect of SSRIs in pregnancy. Antidepressant use and pregnancy ~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~ 2. Alzheimer's disease and vitamin B3 - niacin ~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~ Alzheimer's disease affects almost half of all individuals over the age of 85. As we adopt healthier lifestyles in an attempt to prolong our lives, Alzheimer's becomes more of a concern since it is almost an epidemic at the age we wish to attain. I do not know of any medicine that cures Alzheimer's once an individual has it so the main strategy we look for is how to prevent it in the first place. At the present time the only agent associated with prevention of Alzheimer's is estrogen replacement therapy after menopause. With many women avoiding estrogens due to fear of a small but real increase in breast cancer with long term estrogen use, we must continue searching for something else that may prevent Alzheimer's. Investigators have looked at different vitamins in the food we eat to see if any help prevent the onset of Alzheimer's. There is some suggestion that vitamin E may have a preventative role. Recently a study out of the Rush Institute for Healthy Aging and the Rush Presbyterian-St Luke's Medical Center, both in Chicago, Illinois looked at the B vitamins to see if either dietary levels or vitamin supplements were associated with any decrease in the development of Alzheimer's. They found that individuals who consumed the highest levels of vitamin B3 (niacin) (over 22 mg a day) were almost 80% less likely to be diagnosed with Alzheimer’s in the succeeding 4 years than those who took in less than 13 mg of niacin per day (approximately the current recommended daily allowance).The intake amount of the other B vitamins did not seem to show any relationship to an Alzheimer's diagnosis. Foods such as chicken, nuts, beans and peas and enriched grains and rice and wheat bran cereals are high in vitamin B3. Vitamin B3 and Alzheimer's disease ~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~ 3. Reader submitted Q&A - Serzone(R) warning ~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~ "I have just learned that the antidepressant Serzone which I have taken for the past five years has been "black labeled" by the FDA. What does this mean, and why is the drug still on the market?" - MAC The term which is being used is a "black box warning" which is required by the U.S. Food and Drug Association (FDA) where a major side effect problem has been identified with a pharmaceutical product. This is a method of drawing specific problems to the attention of physicians and is designed to help them prescribe products appropriately. In effect, the FDA required the manufacturer, in this case Bristol-Myers Squibb Co., in in December 2001 to put words inside a heavy black box that warns about the chance of fatal liver failure that has been reported with the use of Serzone. Nefazodone is the generic name for this SSRI/tricyclic antidepressant. The warning appears in the drug insert that comes with the medicine, in any advertising of the medicine and in the Physician's Desk Reference (PDR) that doctors use to look up the dose and side effects. The chance of liver failure is rare. The reported rate in the United States is about 1 case of liver failure resulting in death or need for liver transplant per 250,000 - 300,000 patient-years of Serzone (R) treatment. In other words, for each 25,000 individuals taking the drug for 10 years, there was one case of liver failure. Symptoms of liver failure include jaundice (yellowing of the skin), extreme loss of appetite, stomach and bowel complaints and severe tiredness. You ask why the drug has not been withdrawn from the market? I would guess it was because the incidence of severe problems is very low and the medicine has much greater benefit than harm. Additionally, there are many medicines on the market today that have rare but very serious or deadly side effects. If the FDA required all of them to be withdrawn from the market, there would not be many prescription medicines left standing. Even Tylenol(R) would not make the cut. The best action you can take right now is to see your physician who placed you on Serzone and ask if you can have blood chemistries performed to check for any elevated liver function enzymes. If they are normal, you will then have to decide if you wish to stay on the drug or be switched to another. Be careful though; they all have rare reactions that can be serious. It is best to try to discontinue all of the medicines you can, otherwise there is always the risk of a serious reaction to them. ~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~ 4. Gingivitis ~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~ Inflammation of the mouth gum tissue is very common and as many as 80% of individuals have some degree of gum infection. Bacteria in the mouth and minerals in the saliva form dental calculus between the teeth and gums. This scaly mineral deposit that the dental hygienist chips off when you have your teeth cleaned provides a site for additional bacteria. These bacteria cause further gum inflammation. If infection stays too long between the teeth and gums, eventually the bone of the jaw that holds in teeth can also become infected. Bone infection is very difficult to cure with antibiotics once it gets going. Eventually the bone infection, periodontitis, causes the teeth to loosen and eventually fall out. Repetitive bleeding of the gums when you brush your teeth is a sign of gingivitis. Sometimes the gums become swollen and tender but not very painful. Regular brushing of the teeth and dental flossing is the way to prevent gingivitis but a visit to the dentist for regular teeth cleaning also helps make up for those times when we forget. Certain conditions predispose to gingivitis: any medicines that decrease saliva production diabetes smoking pregnancy decreased immunity genetic predisposition To keep your gums healthy, Mayo Clinic offers the following suggestions: Choose the right toothbrush Use fluoride toothpaste Brush twice daily Angle your toothbrush to 45 degrees to get under the gums Floss daily And don't forget the regular visits to the dentist. Gingivitis ~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~ 5. Health tip to share - Heartburn ~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~ You should seek medical advice when: heartburn occurs several times a week heartburn wakes you up at night on a recurrent basis heartburn comes back shortly after using an antacid FRJ If you have discovered ways of coping with a disease or condition and it works for you, please share it with us: Health tip suggestion form ~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~ 6. Humor is healthy ~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~ Thoughts on aging Eventually you will reach a point when you stop lying about your age and start bragging about it. The older we get, the fewer things seem worth waiting in line for. Some people try to turn back their odometers. Not me, I want people to know "why" I look this way. I've traveled a long way and some of the roads weren't paved. How old would you be if you didn't know how old you are? When you are dissatisfied and would like to go back to youth, think of Algebra. You know you are getting old when everything either dries up or leaks. One of the many things no one tells you about aging is that it is such a nice change from being young. One must wait until evening to see how splendid the day has been. Ah, being young is beautiful, but being old is comfortable. Old age is when former classmates are so gray, so wrinkled, and so bald they don't recognize you. If you don't learn to laugh at trouble, you won't have anything to laugh at when you are old. And best of all-- I don't know how I got over the hill without getting to the top. ~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~ That's it for this time. Your BACKUPMD on the Net. Rick Frederick R. Jelovsek MD ~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~
****** Woman's Health Newsletter ******* January 12, 2003 ~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~ Biweekly from BackupMD on the Net ~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~ 1. Is female sexual dysfunction a new disease? 2. Age bumps and melanoma skin cancer 3. Reader submitted Q&A - Arthritis flare after HRT 4. Heart disease knows no gender 5. Health tip to share - Ice cream headache 6. Humor is healthy The next newsletter will be in two weeks. ~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~ 1. Is female sexual dysfunction a new disease? ~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~ An interesting (and bound to be very controversial) article about defining the entity of female sexual dysfunction has recently appeared in the British Medical Journal. In it, the author essentially accuses the pharmaceutical industry of sponsoring the definition of female sexual dysfunction so that they can conduct clinical trials that might show their drug sildenafil (Viagra) to have a place in treating women just as it does in treating men who have "erectile dysfunction". The author states that "a cohort of researchers with close ties to drug companies are working with colleagues in the pharmaceutical industry to develop and define a new category of human illness at meetings heavily sponsored by companies racing to develop new drugs." Since this main drug, sildenafil, accounts for over 1.5 billion dollars in sales, we have to take this concern seriously, i.e., that they are trying to create a medical market for which they have a drug. On the other hand, maybe this is an area which has been overlooked by physicians as something that they should be identifying and offering treatment for. As best I can tell about the development the author makes reference to, a consensus panel (with pharmaceutical ties) divided female sexual dysfunction into four categories of disorders: sexual desire disorders (libido) sexual arousal disorders orgasmic disorders sexual pain disorders The purpose was to identify arousal in the female as a problem separate from the lack of desire or interest in having sex. It is this area that the pharmaceutical companies were interested in to see if a drug like sildenafil could play a role. In other words, this would target women who say it isn't that they do not have any desire to have sex, but rather they just have major difficulty becoming sexually aroused even with an adequate stimulus. Once this category of "medical problem" was defined, clinical studies could be conducted to see if drug treatment could play a role in reducing the problem. Of three studies that have been conducted in women with "arousal disorder" that I could find, two have shown no benefit from sildenafil and one showed only a slight benefit. Thus there is still a question as to whether there is a separate disorder in women of "arousal problems" versus "desire" problems as there is in men. The article itself is worth reading but more fascinating are the comments by readers that follow the article as to whether this is just a contrived problem for financial benefit on the part of pharmaceutical companies or an overlooked problem that needs medical attention. What do you think? The making of a disease: female sexual dysfunction ~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~ 2. Age bumps and melanoma skin cancer ~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~ Seborrheic keratoses (age bumps) are elevated skin lesions that come with age. They may appear as large freckles that are scaly, raised and often darkened (pigmented) more than a normal freckle so that they can be hard to differentiate from a melanoma skin cancer. As one gets older, they can appear frequently all over the body. This presents a problem if one has many seborrheic keratoses to be excised from the skin. Should every one be sent to pathology to make sure they are not really a malignant melanoma skin cancer? The following study in the Archives of Dermatology looks at how often skin lesions that are thought to be seborrheic keratoses turn out to be melanomas. The investigators looked at over 9000 consecutive pathology reports containing a diagnosis of seborrheic keratosis in the clinical information provided with the biopsy. We do not know how many lesions were removed so the 9000 represents a subset of seborrheic keratoses treated by those physicians. Among all of the biopsied lesions, less than one percent (0.66%) were identified as melanoma. While this is not a high number, it is a real possibility, so the authors recommend the practice of submitting all biopsies to continue. However, it is important for you to know that these lesions rarely turn out to be malignant. Age bumps and melanoma skin cancer ~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~ 3. Reader submitted Q&A - Arthritis flare after HRT ~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~ "Is it normal to have significant joint soreness after quitting H.R.T.? My Dr. took me off about 4 months ago and I now feel 10 years older as far as stiffness and joints are concerned." "I am 63 years old and took H.R.T. for 8 years. I take a mild med for high blood pressure and average meds for thyroid. I went off H.R.T. all at once and have since heard that others tapered off gradually." "I have not been back to my Dr. as I am in the middle of changing insurance companies again. I've checked with many pharmacists and none of them have heard of this problem." - RUE What you describe is not common, but physicians hear this frequently as far as joint and muscle pain flare up upon discontinuing hormone replacement therapy (HRT) or estrogen replacement therapy (ERT). With either arthritis or muscle conditions, the relationship of hormone therapy is somewhat complex. Osteoarthritis in humans does not seem to benefit at all from HRT/ERT even though there is evidence in animals that it may play a protective role. Osteoarthritis, and thus its joint pain, should not worsen with HRT withdrawal. Rheumatoid arthritis sometimes benefits from HRT/ERT especially if there is an overall calcium loss. Any arthritis associated with cortisone-like therapy (glucocorticoids) especially is helped because the estrogens in HRT/ERT help prevent bone loss which worsens the joint pain. An excessive rate of bone loss, osteoporosis, can be superimposed upon any type of arthritis, even osteoarthritis. Therefore going off the HRT could make joint pain worse if there is an osteoporosis component going on. I would suggest asking your doctor to order a bone density scan to see if your total body bone mineral density is low. If so, you can take non- hormonal medicines such as raloxifene (Evista®) or bisphosphonates (Fosamax®,Actonel®, Didronel®). You should be taking calcium supplementation at least 1500 mg a day and a preventative like raloxifene whether or not your total bone mineral density is low. Finally, make sure your doctor is evaluating you for what type of arthritis you might have or refer you to a hematologist for diagnosis and consultation. IF you have an early rheumatoid or osteoarthritis, diagnosing it at this stage may help you slow the progression of joint inflammation down. A last alternative is to consider resuming the HRT. The benefits (decreased joint pain) may outweigh the risks (about a 1% increase in breast cancer) of taking it. I have not heard of any advantage of tapering HRT but I doubt it would be harmful and perhaps it would allow the body to accomodate to withdrawal easier. ~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~ 4. Heart disease knows no gender ~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~ Heart disease is the number one cause of death for women. I suspect most of our readers know that but across the country, many women have other concepts as to what they are at the most risk for. In order to delay that time of a fatal heart attack, exercise and diet are the best prevention strategies. The following suggestions from Personal MD.com may help remind us to keep our health resolve: 1. Buy the deepest color of ground beef you can find. The darker the red, the less fat it contains. 2. Do your own yard work. Mow your lawn. Rake the leaves or grass. It's great exercise for your arms. 3. When eating at a restaurant, split an entree. Portions at restaurants tend to be large. Before eating a pizza, blot up the oil with a napkin. 4. Take the stairs whenever you can. Each flight burns 10 calories and keeps your thigh muscles toned. 5. Don't use creamy dressings or croutons on your salad. If you must have something crunchy on it, walnuts can be a good alternative because they are high in omega-3 fatty acids. 6. When talking on the cordless phone, stretch your arms and legs or do arm curls with a can of food in your hand. 7. Keep high-calorie, high-fat foods out of sight in your pantry. Put raw vegetables and fruits in the front of the refrigerator so you see them first. 8. Play with your children or pet. Play chase with the dog or take him for a walk. Take the kids to a park for a game of tag or push them on the swings. Badminton, volleyball and swimming are fun things you can do together. 9. Eat crunchy, healthy snacks such as carrots, celery or rice cakes instead of chips, cookies and soda. 10. Walk as much as you can. Park you car at the far end of the lot, and walk to the grocery store or the dry cleaners. When you take your kids to soccer practice, spend the time walking around the field while your kids play. Heart disease knows no gender ~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~ 5. Health tip to share - Ice cream headache ~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~ Ice cream headache refers to a short duration headache when eating a cold substance like ice cream. It occurs when very cold food or drink touches and stimulates the roof of the mouth. Over 80% of individuals have experienced this at sometime in their lives. Eating cold food slowly, e.g., ingesting a small scoop of ice cream over a minute or more versus eating it in 5-10 seconds, will reduce the chance of a headache by 50%. But even eating it slowly can produce a headache in 10% or more of individuals. FRJ If you have discovered ways of coping with a disease or condition and it works for you, please share it with us: Health tip suggestion form ~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~ 6. Humor is healthy ~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~ "New Year's Resolutions for Internet Junkies" 1. I will try to figure out why I *really* need 9 e-mail addresses. 2. I will stop sending e-mail to my husband. 3. I resolve to work with neglected children -- my own. 4. I will answer my snail mail with the same enthusiasm with which I answer my e-mail. 5. I will stop sending e-mail, ICQ, Instant Messages and be on the phone at the same time with the same person. 6. I resolve to back up my 12GB hard drive daily... well, once a week... okay, monthly then... or maybe... 7. I will spend less than one hour a day on the Internet. This, of course, will be hard to estimate since I'm not a clock watcher. 8. When I hear "Where do you want to go today?" I will not reply "MS Tech Support." 9. When I hear a funny joke I will not reply, "LOL... LOL!" 10. I will read the manual... just as soon as I can find it. 11. I will think of a password other than "password." 12. I will stop checking my e-mail at 3:00 in the morning... 4:30 is much more practical. 13. I resolve... I resolve to... I resolve to, uh... I resolve to, uh, get my, er... I resolve to, uh, get my, er, off-line work done, too! ~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~ That's it for this time. Your BACKUPMD on the Net. Rick Frederick R. Jelovsek MD ~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~
****** Woman's Health Newsletter ******* January 26, 2003 ~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~ Biweekly from BackupMD on the Net ~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~ 1. Dandruff 2. Night time heartburn and sleep apnea 3. Reader submitted Q&A - Steroids and osteopenia 4. Pap smear interval and cancer of cervix 5. Health tip to share - Yoga for health 6. Humor is healthy ~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~ 1. Dandruff ~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~ Dandruff is a minor health problem that many adults have. It is characterized by flaking skin and itching of the scalp. It is more embarassing than a serious medical concern, but those who have it don't want it. Fortunately most of the time dandruff can be controlled. Actually there are several conditions that can result in itchy, flaky skin of the scalp: dry skin - especially in the winter months, small, non waxy flakes seborrheic dermatitis (classic dandruff) - reddened oily flaky skin with white or yellow scales. often involves eyebrows, back of ears, side of nose, armpits and groins. psoriasis - silvery scales often with skin cracking and bleeding. Involves also elbows, knees, forehead and trunk scalp ringworm (tinea capitis) - the only contagious cause of dandruff causes red, inflamed scalp as well as hair loss contact dermatitis - scalp skin sensitivity to hair products, dyes The cause of most dandruff (seborrheic dermatosis) is thought to be a yeast-like fungus, malassezia, previously called pityrosporum. It is present on most adult scalps but sometimes grows out of control feeding on hair follicle oil. It causes skin irritation which leads to flaking. If you try over-the-counter products and they do not seem to work, you may want to see a dermatologist. they will probably suggest other shampoo treatments varying by the active ingredient in the shampoo. The active ingredient may be zinc pyrithione (Suave Dandruff Control Shampoo, Head & Shoulders), tar-based shampoos (Ala Seb-T, Neutrogena T/Gel, Tegrin), salicylic acid (Ala Seb, Ionil T), selenium sulfide (Selsun, Exsel), and ketoconazole (Nizoral). Sometimes you have to just try different types of shampoos to see what one works the best. It may be necessary to alternate shampoos or switch types if one loses its effectiveness. Be sure to let the shampoo stay on for at least 5 minutes to get an adequate dose of the active ingredient to the skin. Dandruff ~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~ 2. Night time heartburn and sleep apnea ~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~ Gastroesophageal reflux disease (GERD), better known as heartburn, affects many individuals. Investigators have recently found out that individuals with sleep apnea who have heartburn at night, show significant reduction of symptoms when they are properly treated for the apnea. The treatment for sleep apnea is usually CPAP or continuous, positive airway pressure. It is a breathing machine attached to a face mask that the person wears at night and it generates a slight inflow of air that presumably causes increased pressure in the respiratory cavity. The increased pressure must keep down reflux because symptoms of heartburn are reduced by almost 50% when the CPAP treatment is used. I would like to suggest that we consider turning this finding around and ask if symptoms of heartburn are present at night, could that mean a person is more likely to have sleep apnea? The study below did NOT address that possibility but I think that it and other articles offer indirect evidence that should make us consider this possibility. Thus I would recommend to you that if you currently have heartburn that frequently bothers you at night, ask your physician to consider ordering a sleep study for you to see if sleep apnea is a major cause of that heartburn. If it is, then treating the sleep apnea is a much better strategy than just taking oral heartburn medicine because there are many other health problems (eg. tiredness, fatigue) that would be helped along with the heartburn if an accurate diagnosis is made. Night time heartburn and sleep apnea
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